Tag Archives: Mental Illness Awareness

I really don’t get it – anti-psychiatry that is. I can understand that if someone has had a bad experience with a psychiatrist, they might be wary and hostile. After all, not all doctors are good and I have no doubt that most of us have run into a bad one over the course of our lives. I certainly have seen my share of rude, arrogant and stupid doctors from family practitioners to cardiologists but I do not condemn them all. I do not devote my energy to attacking emergency medicine because of a bad ER doc I’ve encountered.

A lot of the anti-psychiatrists I’ve encountered fall into this category. They’ve had a bad experience and generalize to all. But a lot of the others aren’t in this group. They are people who have decided that their time should be devoted to attacking psychiatry as their contribution to freedom of the individual or to the good of mankind. And, for the most part, they know very little of neuroscience, medicine or mental illness. If they truly want to make a difference, they should devote their time to advocating for better care and treatment for the seriously mentally ill or to help with the growing problem of refugees, world peace, homelessness, child poverty, and the list goes on.

For the most part, they are mistaken in their views of psychiatry as Mark Roseman pointed out so brilliantly in his review Deconstructing Psychiatry. I highly recommend that people read that. His analysis is far more detailed than mine but I would like to comment on a few of the common myths that he covers in more detail.

The one complaint that is common among the anti-psychiatry mob is that psychiatrists are controlling people who give an instant diagnosis and then force their patients to take toxic drugs.

People do not go to see psychiatrists by calling one up or walking into their offices. They need to be referred by a general practitioner or via a hospital like an emergency room. And they would only be referred to a psychiatrist if they had psychiatric problems that were beyond the expertise of the general practitioner. That referral would only be made after the general practitioner had ruled out non-psychiatric causes of the symptoms and behaviour.

Like all doctors, the psychiatrist will take a detailed history from the patient, consider possible diagnoses and recommend appropriate treatment. The treatment recommended is based on the professional guidelines outlining evidence based strategies. These are the practice guidelines used by the American Psychiatric Association. Similar guidelines are used in different countries. The cornerstones of any medical practice are to do no harm and to relieve suffering.

I often hear comments and criticisms that a psychiatrist put someone on toxic drugs that they were then forced to take for eternity. A comment to my blog on the anti-psychiatry scholarship at the University of Toronto stated “based on the results of a positive diagnosis (from a 15 minute questionnaire score) a patient (including young children) may receive powerful psychoactive drugs for years, the long term effects of which are not yet known.”

As I said above, the diagnosis is not based on a 15 minute questionnaire but on an extensive evaluation. And, regardless of the medical area, drugs are always (or should be) prescribed in the lowest dose for a short period of time and the patient brought back in for evaluation of efficacy and side effects. The goal is to find the lowest dose that is effective with minimal side effects. This is a process called drug titration.

If the drug is not effective or if it causes too many unwanted side effects, it will be changed. No one is forced to take a drug that does them little good in any discipline of medicine. Surely, the patient does have choice to continue with that doctor or not and to take the advice that is offered. People who see psychiatrists are not held captive.

When it comes to children, they are not seen in isolation as the anti-psych criticism I quoted above implied. They are seen with their families who, understandably, do not want their kids on powerful drugs. There are long discussions with the psychiatrist where all less invasive means are explored. When pharmaceuticals are prescribed, the parents are at complete liberty to stop them if they do not work or if they cause troublesome side effects. The children are not held captive by the psychiatrist and force fed pills against the wishes of the parents.

When a child does continue to take the medication it is because it is having a benefit and there are no troublesome side effects. I remember a mother who resisted Ritalin for her hyperactive child for years telling me how well it worked once she decided to give it a try. “I wish I had tried it much earlier”, she told me. “It would have saved so much grief.”

The anti-psychiatry bunch also assert that mental illnesses do not exist and cite the lack of any one definitive test to prove bipolar disorder, schizophrenia or other afflictions. Quite true but the same can be said for many other maladies. How about Parkinson’s as but one example. Doctors cannot measure the amount of dopamine in the brain (which is depleted in Parkinson’s) to definitively say that the person has the condition. They determine the presence of this condition based upon observing the person and his or her movements.

Alzheimer’s is another. Like with schizophrenia, it is diagnosed by eliminating all possible other reasons for the observed dementia and when none can be found, the diagnosis of Alzheimer’s is made. On autopsy, there will be found specific markers but no one ever gets an autopsy to prove that the doctor was correct. And rarely is anyone with schizophrenia autopsied on death but this is a lengthy list of the abnormalities that demonstrate that it is a disorder of the brain.

The anti-psychiatry group should be looked upon with the same disdain that sensible people look upon the anti-vax faction.

Reading the comments to this blog and others of ours, there is a lot of a-historic and naive thinking. Recently, someone posted my Huffington Post blog on Open Dialogue in Finland to the Spotlight on Mental Health group set up by the Boston Globe to foster discussion of their series on the sad state of mental illness treatment and care in Massachusetts. One person criticized it claiming that I had no right to comment because I have never been to Finland, and the Finnish psychiatrist I quoted had no right to be critical because he had never been to Lapland. This is part of what that person said:

“That paper by Marvin Ross is written around totally wrong information:

1) Marvin Ross has never been to Lapland to check what he wrote; thus he does not know what he speaks about…

2) The psychiatrist whom he telephoned in Helsinki, i.e. some 800 km from Lapland, had never been either…How she knew any of that I do not know.”

One person commented on this blog that 10 times as many people diagnosed with schizophrenia die in the first year post diagnosis than 100 years ago and that olanzapine has killed 200,000 people worldwide.

Taking data from a number of public sources, Dr. Dawson put these statistics together:

Some American Statistics

1880

Total population: 50,000,000

A total of 91,959 “insane persons” were identified, of which 41,083 were living at home, 40,942 were in “hospitals and asylums for the insane,” 9,302 were in almshouses, and only 397 were in jails. The total number of prisoners in all jails and prisons was 58,609, so that severely mentally ill inmates constituted only 0.7 percent of the population of jails and prisons.

Average Life expectancy for entire population: low 40’s for whites

Low 30’s for blacks

2016

2016 total population: 324,000,000

Average life expectancy: men 76, women 81 (lower than Canada and most of Europe, lower still for minority groups. Much of this improvement from 1880 by preventing childhood diseases.)

U. S. Prison population : 2,200,000 (2014)

Or 716 per 100,000 American citizens are in prison. (a seven fold increase from 1880)

Mentally ill in prison estimated/measured to be 30% to over 50%

So 700,000 to over one million mentally ill are incarcerated in US prisons.

Incarceration in jail reduces life expectancy by roughly a factor of 10 years for every 5 years incarcerated. (all inmates)

Estimates/measurements of homeless in the USA: 1.5 to 2 million.

Estimates of homeless mentally ill range from 30% to over 50%.

So 500,000 to one million mentally ill are either homeless or living in shelters.

The homeless mentally ill are not receiving consistent psychiatric treatment. The incarcerated mentally ill may be receiving some limited treatment.

Adding this up:

One to two million mentally ill people are either homeless or incarcerated in prison in the USA.

A high proportion of people with severe mental illness live in poverty.

Severe mental illness without treatment confers higher risks and co-morbidities for several serious diseases, such as cardio vascular disease. People with severe mental illness have a much higher risk of cigarette smoking and poor diet.

Untreated depression, bipolar disorder, and schizophrenia confer a much higher risk of suicide.

Homelessness and incarceration in and of itself reduces life expectancy by a considerable number of years. Neither of these groups is consistently receiving psychiatric treatment.

Psychiatric drugs do have side effects. (as do all pharmaceuticals) In a good outpatient or inpatient facility these can be monitored and treatment adjusted in partnership with patients.

But the real causes of contemporary poor life expectancy of the seriously mentally ill can be found in:

The illness itself untreated

Reduction and closing of hospitals.

Incarceration in jails and prisons

Poor or no housing. Homelessness

Poverty

Poor diet. Illicit drug use. Smoking.

Stigma leading to isolation and victimization

Poor, inadequate, or limited health care

Absence of good consistent psychiatric treatment.

And the overall cost of not providing good early consistent psychiatric treatment in both inpatient and outpatient facilities is calculated in the following article:

Thomas Mulcair, the leader of the Canadian opposition, said that Michael Zehaf Bibeau, the Ottawa shooter, was a criminal, not a terrorist.

This somehow implies to me that being a criminal is even worse than being a terrorist, a “common criminal” rather than an ideologically driven terrorist.

But it does speak of our confusion with this language, and our use of the terms “mentally ill”, “terrorist”, “troubled”, and “criminal” to imply our sympathy, our disdain, or our disgust, rather than a finely tuned definition of each term.

This is the stuff of whole lecture series in the psychological and social sciences but these distinctions might help:

Delusions are explanations for that which is either unacceptable to us, or terrifyingly inexplicable.

The delusion that is the consequence of a mental illness is an explanation for a terrifyingly inexplicable experience.

It can be an explanation, an organization of information when the brain is otherwise impaired in its social information processing, (e.g. schizophrenia, brain injury, dementia), an explanation, or organization for an unusual feeling state, (e.g. mania and grandiose delusions), or an explanation/organization for an otherwise inexplicable sensory experience (e.g. hearing voices, crawling or touching sensations). Such delusions are usually autistic in nature. That is they do not conform to an accepted belief system. (They are not “I have come to believe in God”, but rather, “I am God’s messenger”, or, “I am God”). But they do tend to incorporate the technology and fads and fears of the day. (In 1960 a delusion might include being controlled by radar, or microwaves; today it is more likely having an implanted microchip, or of being pursued by terrorists). Such mental illness-derived delusions usually preclude someone from joining a group, participating in a joint venture, being, for example, part of a terrorist cell – but for a brief span of time, a mentally ill deluded person might find the tenets of Extreme Islam to be satisfying, captivating, and then act upon them.

But one can certainly arrive at this kind of belief and action from different pathways. One can be raised in it, otherwise uneducated, know nothing else but this belief system, and then be pushed to hatred and action by experience, the experience of hatred, loss, failure and grief. It is a delusion of sorts, but one shared by one’s teachers and comrades.

And some troubled young men may, without the presence of a true mental illness-derived delusion, find the tenets of Extreme Islam, the call to action, the promise of significance, the promise of reward and martyrdom, a very convenient solution to their failures, their narcissistic anger and disappointment.

The first hypothetical person, the mentally ill man, is not criminal. At least he will not be considered criminal under the law if it can be demonstrated in court that his delusion, his mental illness, prevented him from having the capacity to know right from wrong and appreciate the consequences of his actions. In the language of Canadian law, he might be found guilty of the act, but not criminally responsible due to mental illness.

The second hypothetical man has been raised within a strict educational and religious system, kept apart from the rest of the world, and been pushed to extremism by the intense propaganda of his teachers (both online and offline) and by his own experiences of loss, hatred, and tragedy that seem to prove them right. He may join IS or a terrorist cell. He may be a true believer in Jihad. A bona fide terrorist.

The third hypothetical man? It would take a psychiatric assessment and a court of law to make a determination. Are his troubles sufficient to warrant a diagnosis of mental illness? Was embracing Extreme Islam a convenient way of channeling his rage? Was he suicidal, or deluded about the outcome of his actions? Would a court of law determine that he had the capacity to know right from wrong and find him criminally responsible? Probably.

Disease, illness, affliction, problem, atypical neurological development, eccentricity, issue, alternate reality, way of life, gift? There is no shortage of words and phrases to name and describe the nature of our struggles to cope, to live and survive in our social world. But each word conveys implications of value, worth, status, promise, expectation, and responsibility. Often these implications themselves determine which word is chosen. About once a month I am told I am about to see (in consultation) a child who has been labeled “gifted”. Whereupon I must try to find a delicate way of asking if “gifted” means Carnegie Hall by the age of 13, or brilliant at quantum mechanics but can’t relate to people, or simply learning disordered, or, careful with these words now, mentally handicapped.

Unfortunately many of the words we use, benign and descriptive at first, over time accrue negative value like small crusty accretions. There wasn’t anything wrong with “retarded” (slowed, behind) until it became an epithet in the schoolyard.

To prevent misunderstanding, but inevitably to obscure, we often fall back on what an editor friend of mine calls “weasel words”, benign enough to not offend, but careless and unhelpful. “Issue” is one of those words, as in “addiction issues”, and “mental health issues.” I don’t know why anyone would say, “He has addiction issues.” rather than, “He is addicted to heroin.” But they do. The use of “mental health issue” is easier to understand, though equally unhelpful. The speaker or journalist is trying to avoid the word “illness”, as in “He suffers from a mental illness.”

A Monty Python skit comes to mind, in which the doctor hesitates while telling his patient that he has, or suffers from, Syphilis. He gets to the word and, instead of speaking it, bends and whispers it into the open drawer of his desk. The patient doesn’t hear the word and asks the doctor to say again. In Monty Python fashion this repeats over and over until….

Actually I don’t remember the ending and I cannot find it on Youtube. But I imagine Michael Palin finally screaming the word, and a few others, at John Cleese.

We avoid the word because of the stigma attached to it, thus increasing the stigma. It was not until we openly used the word “cancer”, that we didn’t run from it, euphemize it, hide it, that it began to lose its stigma. Once free of its stigma the doors opened, research money poured in; clinics, wards, whole hospitals were devoted to helping those who suffer from cancer. The illness cancer, the disease cancer. Not the “cancer issue”.

Terry Fox did not run across Canada with a leg amputated to raise money and awareness for Bone Health Issues.

Every year, the World Health Organization celebrates October 10 as World Mental Health Day to raise awareness and this year their theme is living with schizophrenia. I think we should all pause for a moment and consider just how hard it is for those with this terrible affliction to cope and to commend them for how many of them do cope.

Imagine being a teen just starting out in the world and learning how to cope when gradually you start to become withdrawn, you likely hear strange voices insulting you and telling you to do various things, your reality becomes altered and you’re not sure who your friends are and you begin to misinterpret their intentions and the intentions of your own family.

One of the best depictions of what it is like to have these delusions was by Erin Hawkes who described them to a conference on psychosis at the University of British Columbia in Vancouver last year.

But if the symptoms are not bad enough, those who suffer have to contend with the lack of understanding that so many have of schizophrenia. It is not a moral failure. It is not the result of bad parenting. It is an illness like so many other illnesses and those who suffer deserve to be treated with the respect accorded anyone else who suffers.

And they deserve to get a quality of treatment that others who are ill receive and that includes hospital beds when they need them, proper medical care, psychiatric care, support services like counseling, housing and vocational help.

And, we cannot forget to mention the family. It is devastating to any parent to watch the potential that their teen posses shattered by a horrific brain disease and the lack of sympathy that they often receive from those around them. As Katherine Flannery Dering put it “My younger brother Paul was more than a ‘schizophrenic’. He was a brother, a son, and above all, a person that my eight siblings and I loved.”

So, the next time you see a disheveled street person mumbling away to no one, remember that they are someone’s child and they are likely sick and in need of help.